VIBERT: Opposing, competing realities in health care

Nova Scotia has become two solitudes in health care, most radically and tragically demarcated by children in need of psychiatric care.
A family in Halifax with a child experiencing a mental health crisis is minutes away from emergency treatment and ongoing care at the IWK. A family in Sydney has limited options and no clear choice.
Nova Scotia’s two heath care solitudes can be defined geographically or by medical need, but – like the genesis of the phrase – seem intractable in two opposing and competing realities.
One reality – that of the government and the Nova Scotia Health Authority – is a system undergoing necessary transition. There are challenges, but managed change will lead to better care than before the transition began.
The other reality is what an alarming number of physicians and other front-line care providers report experiencing – dangerous gaps in, and unsustainable pressure to maintain essential medical services. They can find little reason to believe it will get better.
Politically, the two solitudes have hardened to a health system in crisis, or not.
In Cape Breton, there is a crisis in mental health care, and any denial of that fact can only be attributed to misinformation or obstinance. Since 2014, the number of practicing psychiatrists has been reduced from 14 to seven and, when the year is out, just six. There is one, part-time child and adolescent psychiatrist.
Adults in Cape Breton wait 14 months to see a shrink. Reluctantly, psychiatrists have determined they will be unable to provide emergency or inpatient services for children and adolescents, as of the end of this week.
The head of psychiatric services in Cape Breton, Scott Milligan wrote a remarkable memo recently, as Cape Breton Post colleague Nancy King reported last Friday. Coincidentally, the day before King broke the story, I spoke with Linda Courey, head of mental health and addictions at NSHA about the state and future of those services.
Dr. Courey acknowledged there are “challenges” with the current delivery of services, which she attributed primarily to disparate policy, procedures and decision-making, a legacy of nine former regional health authorities.
But, she was confident those issues were manageable in the near-term, and that services would improve at the end of a planning process and with implementation of service access and delivery changes.
Meanwhile, in Cape Breton, psychiatrists “simply do not have the resources to provide the safe, timely and appropriate care . . . young people deserve,” Dr. Milligan wrote, adding that the situation has deteriorated to the point where it “is not a safe way to practise medicine.”
The result: As of Dec. 1, Cape Breton psychiatrists can “no longer see anyone under the age of nineteen . . . in the Emergency Department, nor will (they) be admitting minors to inpatient units.” Cape Breton psychiatrists had been forced to admit minors to adult psychiatric units.
Next Saturday, the family in Sydney with a child in a mental health crisis, can take their chances at the nearest emergency department, or bypass that option and begin the five-hour – in good weather – drive to Halifax and the IWK.
The provincial government’s advice, as stated by Health Minister Randy Delorey in August is:
“If you are experiencing a mental health crisis, our provincewide crisis line is available 24/7 by calling 1-888-429-8167. If you are a young person struggling with a problem big or small, visit kidshelpphone.ca to chat live, or call 1-800-668-6868.” That seems inadequate for true emergencies.
Most Nova Scotians will recall that Cape Breton lost at least three teenagers to suicide in the past year. The province responded by sending psychiatrist Stan Kutcher to investigate and report, and accepted his recommendations. Two more guidance counsellors and a social worker were hired by the Cape Breton-Victoria Regional School Board.
The government also increased youth mental health services and outreach by $1.8 million in the current year’s budget.
In the same statement, Delorey said, “when an individual needs help, the last thing they should have to worry about is where to turn. That’s why we are creating a new central intake system that will make it much easier to access mental health support.”
The central intake is not operational yet, but psychiatrists in Cape Breton are derisive about the concept given experience with such centralized systems proved less, not more effective and efficient.
"Two Solitudes" is a 1945 novel by Canadian writer Hugh MacLennan, who was born in Glace Bay. The title became emblematic of seemingly irreconcilable differences between French and English Canadians, differences that seem reconciled, at least for the moment.
Nova Scotians are condemned to two solitudes in health care, at least until a single reality emerges.

Jim Vibert, a journalist and writer for longer than he cares to admit, consulted or worked for five Nova Scotia governments. He now keeps a close and critical eye on provincial and regional powers.